A comparison of ambulatory care-sensitive hospital discharge rates for medicaid HMO enrollees and nonenrollees

With an increasing volume of Medicaid recipient enrollees in managed care, many states are developing tools for monitoring service quality and access of Medicaid recipients. This article explores the use of ambulatory care-se nsitive (ACS) hospital discharge rates as a simple, practical indicator too l for monitoring the access of Medicaid health maintenance organization (HM O) enrollees through an empirical application in Massachusetts in 1995. Alt hough unadjusted hospital discharge rates were lower, Medicaid HMO enrollee s had higher age-gender-race adjusted total and ACS hospital discharge rate s than Medicaid recipients enrolled in a primary care case management progr am under fee-for-service reimbursement. Higher HMO discharge rates for the specific ACS conditions of asthma and dehydration were suggestive of potent ial HMO access problems.